How to Build a Flexible Culture in Health without Compromising Values with Drex DeFord, Indie Healthcare IT Consultant

How to Build a Flexible Culture in Health without Compromising Values with Drex DeFord, Indie Healthcare IT Consultant

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes rocket listeners, welcome back once again to the outcomes rocket where we chat with today's most inspiring and successful health care leaders really want to thank you for tuning in again. And hey if you like what you hear today or in general I want to ask you to just give us a rating and review on Apple podcasts. Just go to outcomesrockett.health/reviews and you'll be able to rate and review the show and give us some feedback. And even if you don't like it which I'm sure that won't happen with today's guest, let us know and we'll make sure that we make it better. We want to make sure that the show adds value to you so please and thank you. Without further ado, I want to introduce our outstanding guests. His name is Drex DeFord. He's an independent healthcare I.T. consultant. But he has a long list of achievements in health care. He's been the chief information officer at various institutions including Seattle Childrens at Scripps Health and a long list of other things that he's done even in the Air Force. So what I want to do is just open up the microphone to Drex and have them around out that introduction Drex. Welcome to the podcast.

Drex DeFord: [00:01:35] Saul, I'm glad to be here. Thanks for having me.

Saul Marquez: [00:01:38] Absolutely. It's a pleasure to have you.

Drex DeFord: [00:01:39] To tell you a little bit about myself. Yes sure I'll try to do the short version as much as I possibly can. I'm a farm kid from Indiana didn't have money to go to college wanting of joining the Air Force as an enlisted guy went to school as I finished my degree and sort of wound up weirdly in the right place at the right time became a CIO at a small hospital in one of our regions and one of our medical centers was the chief technology officer for Air Force Health in DC for worldwide operations before I retired after an accidental sort of 20 year career. And then who was recruited to Seattle Children's. No sorry scripts health see there's so many of these things I can't even describe. But I went to scripts and was there for a few years. We recruited to Seattle to be the CIO both the hospital and the Research Institute and Steward Health Care in Boston and I did start up with a friend of mine and about two and a half years ago my own shingle and have been lucky enough to be able to work on the things I really want to work on and that I'm good at and not work on the things that I don't want to work on and I'm not good at it. So it's been fun. I'm really very very lucky.

Saul Marquez: [00:02:51] Now that's great Drex I know had an opportunity. Folks I had an opportunity to meet Drex at a health I.T. meeting and struck up a conversation and I was just really moved by some of the thoughts and things that Drex was doing and I just said Drex you have to be on the show the listeners will get a lot from having you on. So I'm really glad we were able to put it together Drex. What would you say a hot topic you feel should be on every medical leaders agenda. And how are you addressing it with your clients.

Drex DeFord: [00:03:22] Hot Topic. Well you know I'm lucky enough now I do get to speak to a lot of conferences and do some some things like that. And when I do that when I engage with any of my clients or really talk about building an organization culture that kind of has the ability to bend and flex and change and be innovative you know ultimately building an organization that can take advantage of and thrive in the new model of health care. Because I see a healthcare storm moving from feet per service to value based care and that's going to happen without a doubt. We have healthcare organizations certainly that are stuck in the peak or service side of the fence and they've built a whole culture around this model and they're taking their sweet time making a change. Not only did it really change. Because it's not fun but you know in my opinion it's time to embrace the stuck. You know as we say in the military. Change means figuring out what what's going to work and what will work what won't work. You're not going to do that overnight. This new model. So I'm always a big proponent of sort of started now build a culture that allows for failure and enter iteration learning fast and taking advantage of the opportunities that are ultimately going to reveal themselves during and after the storm because I think when the storm is over there's going to be a lot of fire sales. And I can almost guarantee you that you're not going to want to be on the wrong side of that MNA. So yeah I think cultural changes being flexible that's kind of a key to the operation.

Saul Marquez: [00:04:54] Drex, I think that's such a great highlight there and I've been a part of great cultures and I've also been a part of not so great work cultures for the leaders listening to your words of wisdom here what would you say in a nutshell is the key to creating an agile amazing culture.

Drex DeFord: [00:05:12] That there's really a bunch of things that go into this. I also one of the things I well it really is this idea that everything is connected everything else. And so trying to change one thing and thinking that if I just do this one thing then everything else is going to fall into place may not be true. But there are things that if you focus on I think you can be more successful and that's really things like relentless prioritization. Right. We have a hundred things going on in any health care organization or vendor or startup or VC firm today. You know there's a hundred things going on and you have to focus. You have to prioritize and that means that sometimes the things that are below the line the things you choose not to prioritize or focus on that doesn't mean those things are bad ideas or things they shouldn't do. It's just that you have to realize that you only have so much energy and you have to focus on the things you focus on. I think for health systems a lot of it is to drive driving hard on analytics and continuing to focus on security because we're definitely in that world now where you just can't afford to have that kind of a stumble or that kind of a problem. So you have to focus on security and then innovation is a big part of it. And innovation is one of those words that means almost anything that anybody wants it to mean. So for me a lot of the innovation is I have a big background in Toyota production systems and lean methodologies. Know again to be at Seattle Children's very organizations very sort of focused on that with three and half years in Japan. I was able to go back and spend time with Yamaha piano and Toyota and others direct mostly on home care. I might be.

Saul Marquez: [00:06:54] How many times did you make it to the White House.

Drex DeFord: [00:06:58] Only once and only as a tourist.

Saul Marquez: [00:07:01] Ok all right. All right.

Drex DeFord: [00:07:03] Yeah but it's it's that kind of stuff. You know there are a lot of components in this that you know and I would say the bottom line probably of all of this is that you have to re orient your organization as much as anything else to focus on the patient. There are a lot of health variations you talk about that today the patient is our customer but saying the patient is your customer and actually acting like a patient is your customer all the time is a huge difference.

Saul Marquez: [00:07:29] That's a great callout directs be a call out. And I think for everybody listening you know what are you doing to make your patient your customer. And I think right now Drex in this health care consumer is a magnificent word. But you know rising deductibles the patient is starting to be more cognisant of where they spend their money and what they spend their money for. And I think it's this is pushing our our healthcare providers to be a little more cognizant of tailoring their services in a way that makes the patient the consumer.

Drex DeFord: [00:08:03] Oh yeah I think so too. And I think the other thing is and we may talk about this more in just a little bit but this idea that especially from information service departments perspective the customer is not the doctor or the nurse or lab of radiology or pharmacy or whatever the case may be. Those pieces of the organization and the AS Department have to be partners in the provision of great care to our customers the patients and family and that every place that I've gone into when I've brought that attitude to the organization. And so. So I'm I'm I'm kind of a change guy I mean a been a change guy my whole career. Unfortunately that replaced that I've been invited into as chief information officer has been specifically to make change. Things weren't going well and that's why the position was open. You know that's why I was hired. And so when you come into it with that you're really sort of changed the whole game for everybody right. Doctors and nurses and lab rat and everyone else start to understand that you're not there to win they say jump say how high. You're there to win they say jump say well let's talk about jump and what that means and what he will do. And you know I want to make sure I have your back in all of this and building that partnership make and make all the difference in the world.

Saul Marquez: [00:09:24] That's a great point. Direct you know you've had a really fruitful career and through the abs and flows you've taken some opportunities to turn around bad situations. Can you give the listeners an example of what you did in one particular situation that helped improve outcomes or helped turn the ship in the right direction.

Saul Marquez: [00:09:45] Sure I spend a lot of time but I spend some time thinking about mistakes that I've made and there's a bunch of them right. I mean I don't think you get to do all the different stuff that I've been able to do. And hopefully as well as I've been able to do it without sort of sometimes falling down and. But the important part of that is really getting back up right. So the problem is easily making a mistake easily usually recognizing that there's been a mistake and then admitting it and doing something about it. So you know there was one that I was I really sort of pull out here and talk about kind of tied to the last part of the conversation it was 2008 probably not long after I arrived at Seattle Children's. We had this really tragic patient incident that led to an accident an accidental medication overdose for a patient and the nurse had made a calculation error. And you know the patient was very sick anyway. And all of this sort of combined together to cause the patient passed away and everyone was crushed. I mean the family of course that the family first and foremost. But when it came to the hospital everyone in the hospital family was also crushed after this had happened and the nurse especially and I don't think people really understand until they were through it when a clinician makes an unintentional error and harms the patient they carry that with them for the rest of their lives is really a terrible burden. And so that children as we brought everybody into the auditorium and it was kind of one group after another for several days in a row and at every different shift and we asked the really simple question What can we do keep this from ever happening again. And we got lots of different responses all sorts of feedback on the way that the system and I don't mean the computer system I mean the capitalist system was broken or had a problem. And for my part as a CIO I kept hearing about how I was looking for consistent patterns places where maybe we were making a mistake or there was there was a challenge and a lot of it was run slow currencies and logging on to computers and sometimes I just go by what I remember because it's hard to get PCs to boot up sometimes takes a long time and all of that very generalizable complaint. And I realized through all that and this is really the lesson mistake that I had made for much of my career going back to this idea that information service shops and healthcare organizations are just a service and support department. And as I said earlier we're way more than that. We're partners with our clinicians in the delivery of great care to our patients and families. We're not something separate seriously I think we are part of the delivery care team and rightfully so. Our teammates expect us to have their backs when the going gets tough and if we do this right they'll have our back too. And so back to the Seattle Children's Story. Slow PCs were impacting patient care and patient safety. They were really just sort of another clinician obstacle to getting the right thing done for the patients and family so I decided that what we have to get out of the PC business which sounded like a ridiculous idea but we've been doing a virtual desktop infrastructure pilot inside that apartment. This was 2009 so hardly anybody was really doing health healthcare. And I said as my CTO job in the name of West right now the CTO etc. and I said Dude we have to get out of the PC business somehow. And so we did. It was a massive effort. We had the backing of the CEO. We had partnerships with a lot of great companies like Citrix anextra hop. We pulled almost all the PCs out of production and replaced with 0 clients in virtual desktops kind of follow clinicians around everywhere that they when they booted up in just a few seconds they didn't take their desks. I mean literally just virtually take their desktop home with them and run them on their own PCs or their own Macs at home. And it went a long way toward convincing everyone on the team that the highest department was a partner in their provision of great care to our patients and families not just a service providers. So every piece of work that I do now with CEOs and vendors and startups and investors now includes that very simple point that you made earlier how is what you did adding to the value a larger team. How's it making care delivery now better faster simpler safer easier access patients and families. Our customers and the other part of that is how are you being the kind of partner that everybody wants on their teams. It's got to be part of it. So yeah mistakes as they say mistakes have made a few. But it's kind of how do you how do you recover from those when they happen.

Saul Marquez: [00:14:15] Drex, that's such an amazing story. And you know it sounds like you guys definitely shifted in a big way. You didn't just take an incremental step here you shifted in a big way that was thoughtful. You didn't just innovate you listened which is the number one thing that I think led to you guys making an impact that actually mattered. You listened and I really admired that about you even when we were at the conference I mean you are such a great listener and so you took that and you applied it at mass scale and you got out of the PC business and made it so much easier you became a partner instead of getting in the way of clinician's and I think that's so cool. Thank you for sharing that.

Drex DeFord: [00:15:00] Yeah sure no problem no I think the listening you know listening is a key part of it. It would be easy for me to say I'm working on a book with a friend but I'm working on the very early stages of sort of scratching our head about how would we write a book about yes but listening as a part of the concept of empathy as a leader and as a teammate is a huge deal. Empathy is in many ways empathy is just the key to everything. You have to whether it's your enemy or it's one of your teammates you have to understand where they're coming from and what they think and what they need. If you get that then you're way more likely to put together a plan whatever it is. And I am really lucky to see Seattle Childrens was kind of a big evolutionary change maybe not evolutionary maybe intentionally innovative change to bring better service to my teammates and ultimately to the patients and families. But most of the time those mistakes and those changes are little tiny iterative innovations that make things just a little bit better maybe almost unnoticeable. But the ideas that they build that culture that sort of continues to promote that. So can we make mistakes. We'll figure it out and we'll go from there and everything that we're doing we're not doing perfectly. There are mistakes built into it. Our goal in life should be to find those mistakes and make them less of a mistake or eliminate them in the process. And again if you can do that with empathy in mind you are much more likely to be successful.

Saul Marquez: [00:16:41] That's a great message Drax and you know I think I'm excited for this book when it comes out. Let us know any better.

Drex DeFord: [00:16:48] We'll see if that ever actually turns into a book but it may turn into a series of blog posts or I'm not sure exactly what's going to happen.

Saul Marquez: [00:16:55] Which would be cool too and a little bit later here we'll be able to share your website with the listeners so that they could tap into some of the blog posts that you do. Drex is definitely an amazing contributor not only to his clients but also to the health space as a thought leader. So definitely make sure to check out his info here. We'll provide it to you soon. Drex, not to get in the weeds but you know we had some changes recently with the executive order of Trump. Now what are your thoughts on all of that. You know as we dive into this how do you think that's going to impact health care.

Drex DeFord: [00:17:29] A really kind of set of questions and we could probably spend the whole day talking about those. But I go back to this idea of flexibility and creating organization the table to take advantage of whatever might happen to tear up the old Marine Corps saying simplify I used and tell my things and I and my team today Semper Numbi right. You know always flexible. I don't know what that means ultimately I know that there's a lot of change and I know that there are things that health systems may have been counting on to happen that may or may not happen here today but I think it's pretty clear to me we are running downhill towards value based care and that's going to happen right. So no matter how you slice it whether it's a single government payer or it's a model like we have today with a lot of payers including the government they want to move toward value based care. So the best thing you can do is to keep your eye on that and that's going to happen. How do you go through this process of working with your clinical partners and your payer partners and everyone else that's involved in the healthcare industry. How do you go through this process of making the transition and doing it in a way that makes sense for you and makes sense for your market makes sense for your patients and families if you focus on that. I think the other side you know regulation or regulation there. You'll figure that out. Don't start digging your heels in fee for service and you say I'm not going to do anything until they figure this out because I can tell you there's going to be a really bumpy ride and by the time they figure it out you better already be down the road or you're going to be on the wrong side of that. And today she talks about it.

Saul Marquez: [00:19:14] But Drex and I appreciate you saying that you know. Friends, we have to make sure that we are not distracted by the noise and the things that happen in the news and ensure policy it's noise. But I think direct says has highlighted for us that where the puck is going is value based care. And if you stay focused on that laser focused you're going to get an outstanding performing culture that is in it for the long haul tracks. What's the proudest. One of the proudest medical leadership moments that you've experienced to date.

Drex DeFord: [00:19:49] Wow. I would say that's a tough one to say. I think probably I don't know that it's a particular high or event but it's probably more that people that team teammates that I've worked with over the years the folks that I've coached and mentored. But many of them have coached and mentored me right back. So that's great. I've been left you know fine really smart people who want to do that do the right thing and that really is kind of you know solving our problems. I've been able to mentor some really great folks and gone on to be amazing CIOs and CPA folks like Patrick Thomas who recently retired CIO Scripps and Julie Berry replaced me as CIO steward and of course I can't forget West Wright who was with me in the air force and at Scripts Health and in Seattle Childrens. And I'm proud to have been mentored by some really great people like Ivan Nelson who most people probably knows the founder of Healthlink that owns for health resources. He gave me my first shot as a CEO and then you guys like Ralph dilatory the CEO Stuart who has has a whole different radical way of looking at health care and that has proven to become the new model of healthcare. So from a personal standpoint I would say the things I'm most proud of are probably my time as the time chair of the college healthcare information management executive chair. It's great learning experience for me again surrounded by a bunch of other great CEOs and a great staff led by rich Karylle and Keith Brandenberg. People like that around it's pretty easy to make that things happen. We hired Russ Frenzel the CEO of Time during that during that time period too and that's proven to have a positive long lasting impact on the college. Oh and now I'm I'm the I'm a board member at center gearstick which is best in class healthcare security consulting firm with great we recently Mack McMillan and David just joined us back in February. See this is another one of those things where you scratch your head and go I don't know why these things happen to me or how they happen nothing happened so bad. Back in February we rang the closing bell on the New York Stock Exchange and that was just a crazy moment to experience. So a lot of good stuff that happened to me throughout my career. A very lucky guy. I don't know. Wake up every day. Just so you know. Today's the day they're going to find out that it was just not me.

Saul Marquez: [00:22:05] That's awesome. Now directs. I love it. And you know the message friends as you are the average of your five closest peers and. Yeah yeah yeah. And you agree with that right, Drex? Surround yourself with amazing people. You're going to do amazing things if you surround yourself with bad people you can do bad things and so Drex you've been surrounding yourself with amazing people. You're an amazing person and you just continue making things happen in healthcare and I think that's a strong message. Tell us about an exciting project or focus that you're working on today.

Drex DeFord: [00:22:39] Yeah thanks. I'm kind of all over the place I work with health systems and vendors and startups and investors and it's all pretty exciting but I guess I'm going to pick out one thing right now that could turn out to be a very big deal under a product development effort with major health care I.T. and that's no renovation. And one of their vendor integration partners can provide a lot of details. Unfortunately because we're kind of in the early stages of it and under NDA if we figure out how to create this product in the right way and if we can do it at the right price point I think we could kind of radically change the way healthcare organizations deliver services to clinicians eliminate distractions improve workflow getting vitality out of the way eating technology out of the way is a huge deal that I've discovered over the course of my career and in the hospitals and clinics where we pilot and clinicians have fallen in love with it. And I guess most of all I would say you know it's not just a technology solution it's a workflow driven solution that's enabled by great tech. So I'm in the early stages right now doing that. Tell me why this is a stupid idea. Discussions with healthcare execs across the country and so solve the hidden probably Southern California in Dallas during the end of the year and it all plays out I'll be able to tell you a lot more about it in 2018.

Saul Marquez: [00:23:59] Way to put a hook in. I love it. Keep up with your blog to make sure that I know what's going on but this sounds exciting so and if you're anything Drex. I'm sure that there's something there so really appreciate you sharing that. Let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. That's the one of course or the ABC is of Drex DeFord and so we're going to write out a syllabus for questions. It's going to be a lightning round. Then finish up with a book that you recommend to the listeners. You ready.

Drex DeFord: [00:24:33] Ok I'm ready.

Saul Marquez: [00:24:34] Awesome. What is the best way to improve healthcare outcomes.

Drex DeFord: [00:24:38] Yeah that one's easy. We've already talked about it remember always that the customers the patient family it's easy to lose that truth. Air quotes truth in the complex and chaotic healthcare environment that we've built. But that's that's true for us. For all the other stuff that we do in our industry.

Saul Marquez: [00:24:57] What is the biggest mistake or pitfall to avoid.

Drex DeFord: [00:25:00] I would go back to prioritization. You have to focus your energy on a limited number of things if you really want your organization to make a difference and if you can't do that then it's hard to understand what you really stand for you have to focus.

Saul Marquez: [00:25:13] How do you stay relevant as an organization. Despite constant change.

: [00:25:18] Yeah I talked about this earlier to embrace the suck. OK change her. It's no fun. We don't like it as humans. I actually did write a blog post about a year ago about healthcares antibodies to change and how we seem to have people who have has an additional position description stop all things from changing and they come out of the woodwork when you have a new idea and they just attack it and your organization and you have to get rid of those people. You have to embrace the. You have to create that organization that's nimble and agile and really to take advantage of opportunities as they arise. One of the quotes I use all the time is from Darwin and actually not from Darwin I always say that Darwin is misquoted as not the strong who survive those who can change the quickest. Right. So in today's environment it's not the big fish the small fish it's the fastest and the slope. So don't be a slippage.

Saul Marquez: [00:26:12] Love it. Embrace the suck and wonder one. I love that. I'm going to put that in a quote right here my recording booth that extracts you made the booth ball what what's one area of focus that should drive all else in the company.

Drex DeFord: [00:26:27] In my company. And remember I'm really a solo independent consultant so it's just me but for me it's about working on hard problems number one. Number two that make a difference to patients and families. And number three working with people that I like or people that I think are smart and that I can learn from. So I mean that's for me. Those are the three things that that helped drive me or were different people and those are pretty broad. So there's a lot of things that can wind up getting into those arrangements but that's what works for me.

Saul Marquez: [00:27:00] And finally Drez what book would you recommend to the listeners.

Drex DeFord: [00:27:04] So now I read lot more than I ever have work. So can I give you a couple. Actually.

Saul Marquez: [00:27:08] Absolutely. Give us a go.

Drex DeFord: [00:27:11] I would say Jay Samit Disrupt you. There's hope back and great ideas in that book and it's a pretty easy read and you'll put new stuff from the book to work every day. And even as he read the book Jay Samit Discrupt you and then I had another really good book called Give and Take Why Helping Others Drives Our Success by Adam Grant. This was a book that was a friend of mine Jeremy Shumack who's the CEO of Blue Tree. He's become a good friend of the last couple of years. He actually gifted that book to me at one point after an early conversation and as Shaw says that giving away your time to others is just good karma. And in the end you get it you get back way more than the universe has a way of balancing themselves. So I really like that book. And then I'm also in the process of reading just finishing now the subtle art of not giving a by Mark Manson of that book that's actually a quick fun read and it drives home the point that you only have so much energy so you have to relentlessly prioritise and all of that for me a lot of it was just reinforcing the way that I kind of go through life anyway but it's good to have that reaffirmation of history I really like life. There's a lot of a lot of great books out there but those are the stories that I would say.

Saul Marquez: [00:28:33] There's the top three so listeners we have an amazing syllabus here put together for you with three amazing books go to outcomesrocket.com/drex and you'll be able to find that syllabus as well as the shownotes for the things that we discussed with Drex and and so don't worry about writing any of the stuff down all the links will be there. Drex, before we conclude. Please share a closing thought with the listeners and then the best place where they get in touch with you including your blog site that we've talked about.

Drex DeFord: [00:29:05] You know. So my blog site is really not nearly as good at this as I probably should be. So the blog stuff that I write usually is on Linkedin cool you know so you can publish stuff there now and I don't write nearly as often as much as I should. But you have an author has not fluff that you can find me on LinkedIn of course and then Web site is really simple. www. drex.io. I know you can always email me at drex@drex.io I'm pretty good about responding. Follow me on Twitter and @drexdeford. I know Donald Trump but I do tweet about some pretty cool stuff from time to time and like I said I'm very particular on LinkedIn so I get a kick out of hearing what everybody's working on and closing thought that's a good one. I think I'll talk about this probably as a personal thing but right if you do the right thing you have integrity that's probably to me the most important personal trait to have. In the end it is new. I think in the end you only have your reputation and that really ensure your integrity and you know for everybody listening to this you were raised right. You know the right thing to do and if you're in turmoil about it because you feel like something that you're going there is a gray area. Go ask your mentor or ask somebody you admire they can help you with that. So if you start with integrity as an anchor then everything you do will make sense. You know people right all seem to fit and it will be consistent. And so do the right thing. That would be my my final word.

Saul Marquez: [00:30:38] I love it. Drex thank you so much for sharing that and really appreciate your taking the time to be on the show with us. Spent some really great time talking about some valuable things and I know the listeners are going to get a lot out of it. So really appreciate your time.

Drex DeFord: [00:30:52] Oh my pleasure. Keep up the great job of podcasts. I mean you are you're interviewing some really cool and interesting people. I love that you do the show notes. It's really easy to get to and listen to. And you know when you're driving in your car whatever. It's really great till you're doing a good service. And so you know speaking for me. But I think probably for a lot of your listeners thanks this has been great.

: [00:31:18] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.